The Lancet. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage

[Giuseppe]

[Source: The Lancet, full text: (LINK). Abstract, edited.]

The Lancet, Early Online Publication, 15 May 2012

doi:10.1016/S0140-6736(12)60357-2

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Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage


Original Text

Prof Anne Mills PhD, John E Ataguba MPH, James Akazili PhD, Jo Borghi PhD, Bertha Garshong PhD, Suzan Makawia BSc, Gemini Mtei MA, Bronwyn Harris MA, Jane Macha MA, Filip Meheus MSc, Prof Di McIntyre PhD



Summary

Background

Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis?integrating both public and private sectors?of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania.


Methods

We used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits. We collected qualitative data to inform interpretation.


Findings

Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries.


Interpretation

Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality.


Funding

European Union and International Development Research Centre.
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[Giuseppe]

Re: The Lancet. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage

[Source: The Lancet, full text: (1) (LINK), (2) (LINK), (3) (LINK). Edited.]

(1) [Correspondence] Department of Error



Pronyk PM, Muniz M, Nemser B, et al, for the Millennium Villages Study Group. The effect of an integrated multisector model for achieving the Millennium Development Goals and improving child survival in rural sub-Saharan Africa: a non-randomised controlled assessment. Lancet 2012; published online May 8. DOI:10.1016/S0140-6736(12)60207-4?Some changes have been made to this Article (see accompanying Correspondence). In the Summary, the last sentence of the Background section should have read ??and compare these changes to local reference data?; the third last sentence of the Methods section should have read ?To assess plausibility and attribution, we compared changes to reference data gathered from matched randomly selected comparison sites for the mortality rate of children younger than 5 years of age?; the last sentence of the Findings section has been deleted; and the Interpretation section should have read ?An integrated multisector approach for addressing the MDGs can produce rapid declines in child mortality in the first 3 years of a long-term effort in rural sub-Saharan Africa?.


(2) [Correspondence] Errors in a paper on the Millennium Villages project

In our paper on the effect of an integrated multisector model for achieving the Millennium Development Goals and improving child survival in rural sub-Saharan Africa (published online May 8), we made some erroneous statements and assumptions.


(3) [Correspondence] Errors in a paper on the Millennium Villages project ? Editors' reply

The Millennium Villages project is an ambitious decade-long effort to find solutions to predicaments facing millions of people living in extreme poverty. Conceived as a means to harness multiple interventions?across health, education, and agriculture, among other sectors?in the quest to improve the lives and livelihoods of these most disadvantaged populations, the project has attracted considerable attention and controversy. That controversy has continued with the recent publication of an interim analysis of Millennium Villages by Paul Pronyk and colleagues.

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